Healthcare Provider Details

I. General information

NPI: 1972618056
Provider Name (Legal Business Name): JEFF GLOVER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 ASTON AVENUE
MCCOMB MS
39648-2825
US

IV. Provider business mailing address

PO BOX 746
MCCOMB MS
39649-0746
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-2481
  • Fax: 601-684-2488
Mailing address:
  • Phone: 601-684-2481
  • Fax: 601-684-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10993
License Number StateMS

VIII. Authorized Official

Name: JEFFREY HENRY GLOVER
Title or Position: PRESIDENT
Credential: MD
Phone: 601-684-2481